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فارسی
Cataract is clouding of the lens of the eye, and its effect on vision is such that the affected person has a clouded vision or a bit like looking through a frozen or foggy window.
Cloudy vision caused by cataracts can make it more difficult to read, drive a car (especially at night), and recognize details in other people’s faces.
Most cataracts develop slowly, that is, it takes a relatively long period, and they do not disturb vision in the beginning. But over time, cataracts eventually impair vision.
The way cataracts form is that the proteins and fibers in the lens begin to break down and cause the vision to become cloudy.
Cataracts are mainly caused by aging, but some genetic disorders and tissue damage to the lens of the eye are caused by various causes such as inflammation or previous eye surgery, diabetes, smoking, obesity, high blood pressure, alcohol addiction, Long-term use of steroid drugs and hematopoietic stem cell transplantation (HSCT) are also considered to be an important part of the root causes of cataracts.
Cataracts commonly occur in patients with ocular GVHD (oGVHD) and are multifactorial in origin, resulting from concurrent toxicity from chemotherapy agents, total body irradiation (TBI) for pretransplantation preparation, and long-term systemic steroids. And it is a local high dose required after hematopoietic stem cell transplantation.
If there is no follow-up and timely treatment, it can be safely said that cataract is the most common cause of vision loss in oGVHD.
Posterior subcapsular cataract is the most common occurrence and is present in most cases. Nuclear sclerosis is also present in many cases, but is relatively more common in older patients, suggesting a rotating cataract component.
In the majority of patients, cataract occurs simultaneously with dry eye syndrome (DES) and makes this treatment more complicated.
Normally, avoiding strong light and using stronger glasses can help to deal with cataracts.
If vision impairment interferes with normal activities, you may need cataract surgery. Fortunately, cataract surgery is generally a safe and effective procedure.
However, when cataracts and dry eye syndrome occur simultaneously in patients with GVHD, the treatment will be more difficult.
Since cataract surgery can induce or exacerbate a pre-existing DES, it is important to first treat DES aggressively and optimize the ocular surface in oGVHD before cataract surgery.
Frequent use of dry eye medications, local anti-inflammatory and immunosuppressant treatment, use of punctal plugs if needed, and previous treatment of any eyelid and adnexal pathology are important.
Another challenge before surgery is accurate biometry and intraocular lens power calculation, and in this regard optical biometry and topographic evaluation are both recommended to be performed more than once.
In case of non-compliance, it is better to postpone the surgery but continue the treatment until the eye surface is optimized and re-evaluate before the surgery after a few weeks.
Considering the existing sensitivities regarding the eye as an important organ, frequent follow-ups of the patient and their companions along with their effective cooperation with the doctor and treatment staff will be of particular importance.
Author and Translator: Dr. Shima Rasooli
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